The Shadow Welfare State: Labor, Business and the Politics of Health Care in the United States (review)

The Shadow Welfare State examines the lack of universal, single-payer health care coverage in the United States and the role organized labor has played in the formation of the current state of health insurance policy. Gottschalk correctly asserts that health insurance policy research has treated organized labor as "little more than a minor player" and an examination of the intricacies behind the shadow welfare state is certainly long overdue. This book contains an excellent historical institutional analysis of the current state of health insurance policy as it has developed, with organized labor at the center.

The concept of a shadow welfare state is developed by Gottschalk to contextualize health insurance policy as it progressed through collective bargaining within the larger context of a US political economy. In essence, the shadow welfare state is the result of benefits gained through collective bargaining and those achieved through the broader political process. It is through this conceptualization that Gottschalk is able to examine the interplay between private and public spheres without the "linear model of welfare state development [which has] held enormous sway" in the majority of social welfare analyses. The legislated schemes such as those funds under Taft-Hartley, the Employee Retirement Income Security Act, the Employees Health Security Act, and the recent Health Security Act provide the legal limitations of collectively bargained health insurance in the U.S. While this framework is a very useful and insightful analytical tool, the concept of a shadow welfare state is somewhat limited as a way to capture all the complexities found in the very rich data collected.

Gottschalk explores health care insurance primarily by focusing on the historical trajectory of post-war organized labor by exploring health care insurance. Data from several labor organizations, including the United Auto Workers, the Service Employees International Union, and the AFL-CIO, are meticulously referenced and were impressively collected through various secondary sources, personal interviews, reviews of print media, and through careful consideration of vast archival records.

It becomes all too apparent from this data that organized labor is a main culprit in the demise of universal health care insurance, with a result that health insurance coverage is "more like a block of Swiss cheese that excludes wide swaths of the population." Gottschalk illustrates how the development of business unionism paved the way for employer-mandated employment-based benefits. The more recent myopic focus of organized labor on health care competitiveness and rising health care costs, combined with very little imagination, a failure to seize many opportunities, and a lack of coalition building with the broader social justice movement, has most certainly put universal health care insurance off for the foreseeable future.

The value of the primary and secondary material collected and presented in this manuscript makes any short-comings of the book seem almost insignificant. However, Gottschalk's attempt to limit race as a key dimension, through examination of the Reagan Democrats, is somewhat assailable. As well, the failure to include Canadian locals of the internationals within the broader analysis, and not simply as reference points, might very well be a significant oversight. Extending the examination of labor's role back to the Regina Manifesto may have provided more insights.

The Shadow Welfare State is well worth the read and broadly suited for education on U.S. health care social policy. Gottschalk has certainly made a valuable contribution to the field of social policy and labor studies.